Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 01-06046 | KS |
N | 111NN1001X | Nutrition | 01-06046 | KS |
NPI | 1386262319 |
---|---|
Provider Name | Dr. Wyatt Stephens |
First Address | Greenwood, MO 64034-9119 |
Second Address | Overland Park, KS 66223-4849 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2020 |
Last Update Date | 07/07/2020 |